E-Cigarettes: Friend Or Foe

Carolyn Kavita Tauro, CNS Correspondent
‘Tobacco is one of the leading killers in the world’; ‘smoking is harmful for our health’; ‘smoking can cause lung cancer, heart disease’… We have heard it all before. We also know how once someone gets into the habit of smoking it is very difficult, if not impossible for him/her to quit due to the addictive nature of nicotine. So the tobacco industry, with all its so called concerns for the dying population, has come up with a new alternative to smoking – E-Cigarettes.What exactly are E-cigarettes?
E-cigarettes are devices which come in the shape of a pen or pocket torch and look very much like conventional cigarettes. They work by heating a solution that contains nicotine (may or may not) and other chemicals, forming a vapour that the vaper (the user of e-cigarette) inhales. Some categories of e-cigarettes are Rechargeable electronic cigarettes, Disposable electronic cigarettes, E-Go electronic cigarettes, Personal vaporisers, electronics cigars and E-liquids. The Rechargeables (with reusable batteries and replaceable liquid nicotine) are supposedly meant for those who smoke on a light to medium range, while disposables are for social or light smokers, or even for those who are first-timers. The E-Go (with bigger batteries and more options) is designed for those who want ‘more power’ out of their cigarettes. The Personal Vaporiser (or lava tubes) are for heavy smokers and come with LCD screens, controls and removable batteries. The electronic cigars are for cigar smokers and are supposed to be a great substitute for those who want the same rich taste of cigar minus the smell. Last of all, is the E-liquid or E-juice which enables vapers explain a variety of flavours and nicotine strengths to choose from.

E-cigarettes help quit smoking… or do they?
Many smokers, especially the young ones, try e-cigarettes in an attempt to quit smoking. Some intend on reducing their smoking habit or use it in smoke-free public areas. Whether it helps quit or even reduce smoking remains the big question with no proven answers. A study done on quitting success in those who use e-cigarettes versus those who do not, showed no difference between the two. The use of e-cigarettes may actually promote dual use i.e. a smoker would now be a vaper too. In a study done on Korean adolescents using e-cigarettes, it was concluded that those who had initiated using e-cigarettes to quit smoking were more likely to use them, but were not less likely to stop using traditional cigarettes. Also, these were strongly associated with current and heavy cigarette smokers.

Although it is said that e-cigarettes are less harmful than traditional cigarettes, studies show that they still contain harmful substances in varying amounts. These substances include nicotine, ultra particles and volatile organic compounds, which are known to harm if inhaled repeatedly. E-cigarette puffing or vaping increases risks of hypertension and cardiac arrhythmias (erratic heart beats) which could results in adverse effects. In some cases, intoxication due to the absorption of nicotine has also been noted.

“The 5.4 million tobacco related deaths occurring every year are not due to a virus or bacteria, but because of the marketing tactics of tobacco companies. E-cigarettes (ECs) are now their new target products,” says Mr. Bill Bellew, of the International Union Against Tuberculosis and Lung Disease (The Union). The marketing and sale of these products result in an increased public presence of cigarette-like images and the behaviour of smoking. They could even promote the habit of nicotine inhalation in non-smokers. “In some cases they are used as smoking cessation aids, while in other quarters they are used to maintain the addiction. The health impact of long time inhalation of propylene glycol—a lung irritant-- is of concern and needs to be fully investigated. Some ECs have shown the presence of di ethylene glycol which has a history of mass poisonings and deaths”, he adds.

We need to know the unknown
Further research is required for this product in the market. More research is required to study the ill effects of e-cigarettes on the user as well as on those around-- namely children, pregnant women and those with cardiac conditions.

“We do not know. We do not have any reports from drug and/or government regulatory authorities or scientific laboratories on what one is vaping actually. We are not even sure if the nicotine in ECs is chemical nicotine or is got from the tobacco leaves. Efficacy studies need to be done to make sure that they can be used only for quitting (as is being claimed by the manufacturers) under prescribed environments. We do not have evidence right now and till we have it we cannot believe in one sided research claimed to be done by the producers of ECs. So till research has happened, regulations need to be put in place”, says Dr. Ehsan Latif. Director, Department of Tobacco Control at the The Union.

After decades of work to de-normalize smoking, these findings raise the question of whether e-cigarettes are re-normalizing smoking. “ECs are trying to renormalize smoking habits”, says Dr Latif, “We as public health professionals need to learn from history and it gives me a déjà vu of the 1960s when cigarette companies told the public that their products are safe (but they were not). The same thing is happening with ECs”.